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Provocation challenge predicts amoxicillin allergic reaction
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Use of a provocation challenge in pediatric patients with a rash and suspected amoxicillin allergy successfully predicted the percentage of patients with an allergic reaction, according to recent research.
“Our study is the first, to our knowledge, to determine the percentage of immediate and nonimmediate amoxicillin allergic reactions through a graded [provocation challenge] in all children presenting with a suspected amoxicillin-induced rash,” Christopher Mill, MPH, from the division of clinical epidemiology at the department of medicine at McGill University Health Centre in Montreal, Quebec, and colleagues wrote in their study. “Our findings suggest that the presentation may be very similar in those with hypersensitivity and those who are tolerant of amoxicillin.”
Mill and colleagues evaluated 818 pediatric patients (median age = 1.7 years) with a rash and a suspected allergy to amoxicillin who underwent a provocation challenge during a course of amoxicillin treatment, according to the abstract.
They found that 770 pediatric patients (94.1%) tolerated the challenge, whereas 17 patients (2.1%) had mild immediate reactions and 31 patients (3.8%) had nonimmediate reactions, according to the abstract.
The researchers then analyzed 346 children to determine subsequent reactions to amoxicillin after negative provocation challenge results. Of these, 250 patients (72.3%; 95% CI, 67.2%-76.8%) responded, and 55 patients had additional amoxicillin treatment. There were 49 of 55 patients (89.1%) who tolerated the challenge, with 6 patients (10.9%) having non-immediate cutaneous reactions.
The specificity of the graded provocation challenge was 100% (95% CI, 90.9%-100.0%) with a positive predictive value of 100% (95% CI, 86.3% - 100.0%) and a negative predictive value of 89.1% (95% CI, 77.1%-95.5%). Predictors of immediate reaction to the provocation challenge included a history of a reaction within 5 minutes of exposure (adjusted OR = 9.6; 95% CI, 1.5-64.0), while nonimmediate reaction predictors included a rash lasting longer than 7 days (adjusted OR = 4.8; 95% CI, 1.4-16.4) and a parental history of drug allergy (adjusted OR = 3.0; 95% CI, 1.3-6.8), according to the abstract. – by Jeff Craven
Disclosure: The researchers report no relevant financial disclosures.
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